2017-11-15T15:14:22-06:00 2016-12-31 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2016-01-01 951816005 Beverly Community Hospital Association BEVE 3237261222 309 West Beverly Boulevard Montebello CA 906404308 Larry Pugh VP FINANCE/CFO 3237261222 2017-11-15 1 Lauren Haverlock P00545829 4159561500 2017-11-15 12.129.7.100 2017-11-15 13:23:45 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A8136467301894A8C824375E05464FC9157A58CD 2016 2017-02-10 21:41:12Z ALICE CHENG 309 West Beverly Boulevard Montebello CA 906404308 189260146 0 X www.beverly.org X 1949 CA TO BE A LEADING, INDEPENDENT NON-PROFIT COMMUNITY HOSPITAL IMPROVING THE QUALITY OF LIFE OF ITS CONSTITUENTS THROUGH HEALTH EDUCATION, DISEASE PREVENTION AND STATE OF THE ART ILLNESS AND INJURY TREATMENT. 9 8 1061 229 0 0 3802201 562238 176979426 188374363 8755 41683 1584175 281862 182374557 189260146 0 5000 0 0 61162951 63607672 0 0 0 109199516 116204828 170362467 179817500 12012090 9442646 154858148 156351860 94880246 86931460 59977902 69420400 TO BE A LEADING, INDEPENDENT NON-PROFIT COMMUNITY HOSPITAL IMPROVING THE QUALITY OF LIFE OF ITS CONSTITUENTS THROUGH HEALTH EDUCATION, DISEASE PREVENTION AND STATE OF THE ART ILLNESS AND INJURY TREATMENT. 0 0 103845844 5000 134384337 INPATIENT AND OUTPATIENT HOSPITAL SERVICES - HOSPITAL SERVICES PROVIDED BY BEVERLY COMMUNITY HOSPITAL ASSOCIATION INCLUDED 8,641 INPATIENT ADMISSONS, 20,474 OUTPATIENT VISITS, AND 37,061 EMERGENCY ROOM VISITS IN 2016. CARE IS PROVIDED WITHOUT CHARGE TO PATIENTS WHO MEET SPECIFIED CRITERIA UNDER THE CHARITY CARE POLICY. THE COST OF CHARITY CARE PROVIDED TOTALED $1,356,000 IN 2016. 44948155 54526107 CAPITATION SERVICES - BEVERLY COMMUNITY HOSPITAL ASSOCIATION CONTRACTS WITH THE BLUE CROSS OF CALIFORNIA AND HEALTH NET OF CALIFORNIA TO PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES AT FULL RISK TO ENROLLED MEDI-CAL BENEFICIARIES WHO ARE CONCURRENTLY ENROLLED WITH A LOCAL MEDICAL GROUP. ENROLLMENT DURING 2016 WAS 1,219,405 MEMBER MONTHS. 148793999 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 725 0 1 1061 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Larry Pugh 3237255095 309 West Beverly Boulevard Montebello CA 90640 X Carlos Manuel Haro PhD Chairman 2.00 2.00 X X 0 0 0 Denton Guthrie CPA First Vice Chairman 2.00 2.00 X X 0 0 0 Lyla Eddington EdD Second Vice Chairman 2.00 2.00 X X 0 0 0 Gautam Ganguly MD Treasurer 2.00 2.00 X X 0 0 0 Rosemary Orozco Secretary 2.00 2.00 X 0 0 0 Krishna Narayanan MD Director 2.00 2.00 X 53500 0 0 Renee D Martinez Director 2.00 2.00 X 0 0 0 K Lawrence Cohen MD Director through July 2016 2.00 2.00 X 82500 0 0 Aziz Khan MD Director 2.00 2.00 X 0 0 0 Alma Perez SPHR Director 2.00 2.00 X 0 0 0 Alice Cheng President & CEO 40.00 3.00 X 412192 0 15430 Larry Pugh VP of Finance & CFO 40.00 3.00 X 277939 0 6081 Wendy R Beesley Senior VP & COO 40.00 0.00 X 262517 0 13470 Kathryn W Ross VP of Nursing 40.00 0.00 X 215877 0 5313 John G Barnes Administrative Dir., H.R. 40.00 0.00 X 199289 0 5334 Ashley Dongying Li Cardiothoracic Coordinator 40.00 0.00 X 190827 0 0 Loretta Manndavis CIO 40.00 0.00 X 187251 0 9693 Lois Long Administrative Nursing Supervisor 36.00 0.00 X 162958 0 12935 Gayle Cantrall Director of Nursing - Surgery 40.00 0.00 X 162852 0 349 Ismael Mendoza Pharmacist 40.00 0.00 X 161002 0 0 2368704 0 68605 124 0 1 0 SODEXHO INC & AFFILIATES 9801 WASHINGTONIAN BlVD Gaithersburg MD 20878 Mgmt Srvcs - Food & Housekeeping 3334010 HOOPER LUNDY AND BOOKMAN WATT PLAZA SUITE 1600 1875 CENTURY Los Angeles CA 90067 Legal services 548769 DOYLE & SCHAFER LLP 8105 IRVINE CENTER DRIVE STE 520 Irvine CA 92618 Legal services 516977 PARADIGM MEDICAL MANAGEMENT 23332 HAWTHORNE BLVD SUITE 301 Torrance CA 90505 Wound care management 474909 LIFELINE DIALYSIS INC 101 W BEVERLY BLVD STE 304 Montebello CA 90640 Dialysis 464400 103 562238 562238 Net Patient Service Revenue 621990 133848256 133848256 Premium Revenue 621990 54526107 54526107 188374363 37895 37895 55194 0 55194 55194 55194 3788 0 3788 3788 3788 Rebates & Refunds 900099 391488 391488 Other Program Revenue 900099 129223 129223 Medical Records 900099 15370 15370 -309413 -309413 226668 189260146 188910444 0 -212536 5000 5000 1549442 357190 1192252 47539948 43209573 4330375 10686150 4210479 6475671 3832132 3493160 338972 789995 789995 572909 572909 78 78 11097892 6168510 4929382 355593 260646 94947 997212 997212 2144782 376488 1768294 3124 2792 332 1152905 1152905 5164034 1273270 3890764 2092891 2092891 Capitated Medical Svcs 44948155 44948155 Medical Supplies 16280200 16273948 6252 Hospital Fee 15581323 15581323 OTHER PURCHASED SVCS 9216420 7146286 2070134 5807315 5487179 320136 179817500 148793999 31023501 0 30927510 11544023 7442513 20170593 13011 0 16759673 20001651 88956 222782 2942632 3041177 2130554 1248547 158212076 84642440 64220910 73569636 96692 98221 30235697 26455230 154858148 156351860 42401947 30749522 40691424 40638073 1067107 4575157 10719768 10968708 94880246 86931460 X 59938594 69420400 39308 0 59977902 69420400 154858148 156351860 9442646 -148 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 141556 141556 0 Part II-B, Line 1: BEVERLY COMMUNITY HOSPITAL ASSOCIATION SUPPORTS CERTAIN INITIATIVES AND ISSUES THAT ARE HEALTHCARE RELATED AND CONSISTENT WITH ITS MISSION OF PROMOTING HEALTHCARE IN THE COMMUNITY. EXPENDITURES INCURRED TO SUPPORT THESE INITIATIVES MAY BE CONSIDERED TO BE LOBBYING EXPENDITURES. AN INDIRECT EXPENDITURE OF THE HOSPITAL'S MEMBERSHIP DUES PAID TO HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA (HASC) WERE USED FOR LOBBYING ACTIVITIES. 1398730 1398730 112854083 62467603 50386480 18559236 14542718 4016518 25400027 7632119 17767908 73569636 Due From Related Parties 3845809 Investment - Closely Held Insurance Company 298011 Third Party Payor Receivables 15491710 Unamortized Loan Costs 2859 Malpractice/Worker's Comp Insurance Receivables 3575000 Assets Limited As to Use 1478326 Beneficial Interest in Affiliate 1439042 Other Receivables 209841 Deposits 114632 26455230 Accrued Self-Insured Liabilities 6422000 Capital Lease Liabilities 1220143 Due to Related Parties 3326565 10968708 X Part X, Line 2: The Corporation recognizes the tax expense or provision from uncertain tax positions only if it is more likely than not that the tax positions will be sustained on examination by the tax authorities, based on the technical merits of the position. The tax benefit is measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. 1 1 X 1 X 350.000000000000 1 X 450.000000000000 1 1 1 0 1 1 1861966 0 1861966 0.01040 80413605 64969055 15444550 0.08590 82275571 64969055 17306516 0.09630 3550018 3550018 0.01970 34775 34775 0.00020 3584793 3584793 0.01990 85860364 64969055 20891309 0.11620 31549 0 31549 0.00020 31549 31549 0.00020 1 9349639 0 32124272 10194888 21929384 X 1 1 1 1 BEVERLY HOSPITAL 309 West Beverly Boulevard Montebello CA 90640 WWW.BEVERLY.ORG 106190081 X X X BEVERLY HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X www.beverly.org/about-us/in-the-community/ X 1 16 1 www.beverly.org/about-us/in-the-community/ 0 1 X 350.000000000000 450.000000000000 X X X X X 1 1 X X X X 1 X https://www.beverly.org/patients/ X https://www.beverly.org/patients/ X https://www.beverly.org/patients/ X X X X X X 1 X 0 X 1 X 0 0 BEVERLY HOSPITAL Part V, Section B, Line 5: THE 2016 COMMUNITY NEEDS ASSESSMENT WAS DEVELOPED THROUGH A COMBINED QUANTITATIVE AND QUALITATIVE INFORMATION BASED ON REVIEW AND ANALYSIS OF DEMOGRAPHIC TRENDS, ECONOMIC TRENDS, HEALTH CONDITIONS, FAMILY AND COMMUNITY ISSUES, EDUCATION AND YOUTH DEVELOPMENT ISSUES, SENIOR SERVICES ISSUES AND COMMUNITY INPUT. THE HOSPITAL HELD FOCUS GROUP SESSIONS AND A SURVEY WITH REPRESENTATIVES FROM A VARIETY OF COMMUNITY-SERVING ORGANIZATIONS TO IDENTIFY KEY THEMES. BEVERLY HOSPITAL Part V, Section B, Line 11: To address the significant health needs identified in the 2016 CHNA, the hospital plans to build on previous CHNA efforts and existing initiatives, while also considering new strategies and efforts to improve health. The following criteria were used by the hospital's leadership team to determine which significant health needs BCHA will address in the Implementation Strategy: (i) whether there is capacity to address the issue, (ii) whether there are programs, systems, staff, and support resources in place to address the issue; (iii) are there existing resources committed to the issue; and (iv) does BCHA have the competencies and expertise to address the issue, and does the issue fit with the organizational mission. As a result of the review of the needs and application of the above criteria, BCHA will address: access to care; chronic diseases; mental health; overweight and obesity; and preventive practices through a commitment of community benefit programs and charitable resources.BCHA will address access to care by taking the following actions: (i) providing financial assistance through both free and discounted care for health care services, consistent with the hospital's financial assistance policy; (ii) provide transportation support to increase access to health care services; (iii) offer information and enrollment assistance in the Covered California health care exchange and other low-cost-insurance programs, as well as information about Medicare benefits updates; (iv) pursue Federally Qualified Health Care status for hospital-based clinics to provide primary care services to underserved populations; (v) renovate the Emergency Department to double the number of ED beds available; and (vi) partner with health care providers to open an Urgent Care facility in Montebello. In order to accomplish the planned activities, BCHA anticipates collaborating with both AltaMed Health Services and the Center for Healthcare Rights.BCHA will address chronic disease by taking the following actions: (i) through the Diabetes Center, provide free diabetes education and host diabetes events (including blood glucose screening and nutrition classes); (ii) offer CPR classes; (iii) host health and wellness fairs for seniors, including screenings; (iv) increase cardiac awareness through health education and screening tests to identify cardiac disease; (v) provide support groups to assist those with chronic diseases and their families; (vi) provide public health education in the media and community health awareness events to encourage health behaviors and prevent chronic diseases; and (vii) pursue stroke center designation. In order to accomplish the planned activities, BCHA anticipates collaborating with the American Diabetes Association, the American Heart Association, the American Stroke Association, the City of Montebello, local churches, the Montebello Police Department EMS Agency, the Montebello-Commerce YMCA, the Montebello Unified School District, Senior Centers, and Telacu - Senior Villas.BCHA will address mental health by taking the following actions: (i) offer community health education, community lectures, presentations, and workshops; (ii) support multisector collaborative efforts that support access to mental health services; (iii) increase community awareness of prevention efforts and availability of resources to address mental and behavioral health concerns; and (iv) pursue Federally Qualified Health Care status for hospital-based clinics to provide mental health care services to underserved populations. In order to accomplish the planned activities, BCHA anticipates collaborating with: the City of Montebello, the LA County Department of Public Health, the Montebello-Commerce YMCA; and the National Alliance on Mental Illness.BCHA will address overweight and obesity by taking the following actions: (i) offer community health education, community lectures, presentations, and workshops; (ii) host health and wellness fairs that include screenings for BMI, blood pressure, and blood glucose; (iii) support the KidsFit program, a 12-week session to help overweight children and their families develop healthy eating and physical activity habits; (iv) provide nutirition classes for the commuity; and (v) support increased breastfeeding edcuation through the Baby-Friendly Hospital Initiative. In order to accomplish the planned activities, BCHA anticipates collaborating with: the East Los Angeles Network for Health California, the LA County Department of Public Health, the Montebello-Commerce YMCA, Pediatricians, and WIC.BCHA will address preventive practices by taking the following actions: (i) provide free health screenings; (ii) provide education and resources focused on healthy living and disease prevention to be offered in English and Spanish; (iii) provide education to teens on abstinence, birth control, sexually transmitted diseases, and pregnancy prevention; (iv) offer free childhood immunizations and adult flu shots; (v) provide TB testing; (vi) through hospital-based clinics, offer breast and cervical cancer screenings at low and no-cost for women through the Family PACT and Every Woman Counts programs; and (vii) pursue Federally Qualified Health Care status for hospital-based clinics to provide primary care services to underserved populations. In order to accomplish the planned activities, BCHA anticipates collaborating with: the local Chamber of Commerce, the City of Montebello, the Firefighters Association, local churches, the Montebello Police Department, the Montebello School District Head Start Program, the Montebello Unified School District, the Montebello-Commerce YMCA, the Pico Rivera Women's Club, and Senior centers.Taking existing hospital and community resources into consideration, BCHA will not directly address the remaining health needs identified in the CHNA, including: dental health, substance abuse, and teen pregnancy. Knowing that there are not sufficient resources to address all the community health needs, BCHA chose to concentrate on those health needs that can most effectively be addressed given the organization's areas of focus and expertise. 1 1 - Women's Care Center 1920 W Whittier Blvd Montebello CA 90640 Outpatient Comprehensive Perinatal Services Program (CPSP) Clinic Part I, Line 7: BEVERLY HOSPITAL USES COST TO CHARGE RATIO TO DETERMINE THE COSTING METHOD. Part II, Community Building Activities: THE COMMUNITY BUILDING ACTIVITIES PROMOTED THE HEALTH OF THE COMMUNITY THROUGH VARIOUS PROGRAMS INCLUDING IMMUNIZATIONS, FITNESS, HEALTH SCREENINGS, TOURS, CLASSES, AND LECTURES. Part III, Line 4: Patient service revenue is reduced by the provision for bad debts and accounts receivable are reduced by an allowance for doubtful accounts. These amounts are based on management's assessment of historical and expected collections for each major payor source, considering business and economic conditions, trends in health care coverage and other collection indicators. Management regularly reviews collections data by major payor sources in evaluating the sufficiency of the allowance for doubtful accounts. On the basis of historical experience, a significant portion of the Hospital's selfpay patients will be unable or unwilling to pay for the services provided. Thus, the Hospital records a significant provision for bad debts in the period services are provided to selfpay patients. TheHospital's allowance for doubtful accounts for selfpay patients was 88% and 91% of selfpay accounts receivable as of December 31, 2016 and 2015, respectively. For receivables associated with patients who have third-party coverage, the Hospital analyzes contractual amounts due and provides an allowance for doubtful accounts and a provision for bad debts, if necessary. Patient accounts receivable are written off after collection efforts have been followed in accordance with the Hospital's policies. Part III, Line 8: MEDICARE: COST TO CHARGE RATIO IS USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS OF CARE. Part III, Line 9b: ALL ACCOUNTS THAT HAVE BEEN DETERMINED NOT TO HAVE INSURANCE COVERAGE NOR QUALIFY FOR CHARITY AND REFUSE TO MAKE ARRANGEMENTS FOR SOME TYPE OF PERIODIC SCHEDULE PAYMENTS, THEY ARE REVIEWED DAILY THROUGH REMINDER QUEUE AND DAILY CONVERSATIONS WITH PATIENTS. IT IS EVENTUALLY DETERMINED WHICH ACCOUNTS THAT ARE NOT WILLING TO PAY BASED ON PRIOR CONVERSATIONS AND DUNNING HISTORY. THOSE ACCOUNTS ARE THEN TRANSFERRED TO A COLLECTION AGENCY. Part VI, Line 2: NEEDS ASSESSMENT: THE 2016 COMMUNITY NEEDS ASSESSMENT WAS DEVELOPED THROUGH A COMBINED QUANTITATIVE AND QUALITATIVE INFORMATION BASED ON REVIEW AND ANALYSIS OF DEMOGRAPHIC TRENDS, ECONOMIC TRENDS, HEALTH CONDITIONS, FAMILY AND COMMUNITY ISSUES, EDUCATION AND YOUTH DEVELOPMENT ISSUES, SENIOR SERVICES ISSUES AND COMMUNITY INPUT. THE HOSPITAL HELD FOCUS GROUP SESSIONS AND A SURVEY WITH REPRESENTATIVES FROM A VARIETY OF COMMUNITY-SERVING ORGANIZATIONS TO IDENTIFY KEY THEMES. Part VI, Line 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PUBLIC NOTICES ARE POSTED OF THE FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE IN THE HIGH VOLUME INPATIENT, OUTPATIENT, AND EMERGENCY SERVICE AREAS OF THE HOSPITAL. NOTICES ARE ALSO POSTED IN THE PATIENT FINANCIAL AND COLLECTION DEPARTMENTS. THESE NOTICES INCLUDE CONTACT INFORMATION ON HOW A PATIENT MAY OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR SUCH ASSISTANCE. Part VI, Line 4: The population of the Beverly Hospital service area was 710,992. Children and youth, ages 0-17, make up 25.9% of the population; 69.7% are adults, ages 18-64; and 11.5% of the population are seniors, 65 and over. The median age in the service area is 34.1, lower than the median age in the county of 35.3. In the service area, 77.3% of the population is Hispanic/Latino; 16.5% of the residents are Asian; 4.8% are White; 0.6% are African American; and 0.9% are American Indian/Alaskan Native or other or multiple race/ethnicity. This is a much higher percentage of Hispanics/Latinos and a much lower percentage of Whites than found at the county level. There are also a higher percentage of Asians and a lower percentage of Blacks than found county-wide. The languages spoken at home by area residents mirror the racial/ethnic make-up of the Beverly Hospital service area communities: Spanish is spoken in the home among 65.1% of the population; English is spoken at home among 18.9% of the population; 15% of the population speak an Asian language; and 1% of the population speaks another language at home. In the service area there are 187,371 households and 198,140 housing units. The median household income is $46,835 and the average (mean) household income is $58,851. These are lower than for Los Angeles County. Part VI, Line 5: PROMOTION OF COMMUNITY HEALTH: BEVERLY HOSPITAL COMMUNITY BENEFITS ACTIVITIES INCLUDED: CHARITY CARE FOR PATIENTS WITHOUT THE ABILITY TO PAY FOR NECESSARY HOSPITAL TREATMENT, ABSORBING THE UNPAID COSTS OF CARE FOR PATIENTS WITH MEDI-CAL, ASSISTANCE WITH PATIENT TRANSPORTATION, ASSISTANCE PREPARING MEDI-CAL APPLICATIONS, SERVING AS CLINICAL ROTATION SITES FOR RN AND LVN STUDENTS AND EMERGENCY MEDICAL AND RESPIRATORY TECHNICIANS ATTENDING LOCAL COLLEGES; SUPPORTING LOCAL PROGRAMS LIKE KIDSFIT TO HELP OVERWEIGHT CHILDREN DEVELOP GOOD EATING AND EXERCISE HABITS AND PREGNANT MINORS PROGRAMS TO PREVENT TEEN PREGNANCY, OFFERING CHILDHOOD IMMUNIZATIONS, CPR CLASSES AND TUBERCULOSIS TESTING, WORKING IN CONJUNCTION WITH OTHER HEALTH CARE PROVIDERS TO PROVIDE HEALTH LECTURES AND SCREENINGS AT CONVENIENT COMMUNITY LOCATIONS, PROVIDING FINANCIAL SUPPORT TO A VARIETY OF LOCAL NON-PROFIT ORGANIZATIONS, PARTICIPATING IN COMMUNITY HEALTH FAIRS, OFFERING SPECIALIZED EDUCATION PROGRAMS FOR THE MANAGEMENT OF DIABETES AND PREPARED CHILDBIRTH, BREASTFEEDING AND INFANT CARE; OFFERING DEDICATED PROGRAMS FOR SENIORS SUCH AS SOCIAL ACTIVITIES, EXERCISE CLASSES, FLU IMMUNIZATIONS, SUPPORT GROUPS, AND AN ANNUAL HEALTH FAIR. Part VI, Line 7, Reports Filed With States CA X X X 0 0 0 0 0 0 0 0 0 Alice Cheng President & CEO 404317 0 0 0 7875 0 0 0 15430 0 427622 0 0 0 Larry Pugh VP of Finance & CFO 267691 0 0 0 10248 0 0 0 6081 0 284020 0 0 0 Wendy R Beesley Senior VP & COO 260933 0 0 0 1584 0 0 0 13470 0 275987 0 0 0 Kathryn W Ross VP of Nursing 206266 0 0 0 9611 0 0 0 5313 0 221190 0 0 0 John G Barnes Administrative Dir., H.R. 194522 0 0 0 4767 0 0 0 5334 0 204623 0 0 0 Ashley Dongying Li Cardiothoracic Coordinator 190827 0 0 0 0 0 0 0 0 0 190827 0 0 0 Loretta Manndavis CIO 186744 0 0 0 507 0 0 0 9693 0 196944 0 0 0 Lois Long Administrative Nursing Supervisor 162848 0 0 0 110 0 0 0 12935 0 175893 0 0 0 Gayle Cantrall Director of Nursing - Surgery 161067 0 0 0 1785 0 0 0 349 0 163201 0 0 0 Ismael Mendoza Pharmacist 159849 0 0 0 1153 0 0 0 0 0 161002 0 0 0 A California Statewide Communities Development Authority 680164610 13080SLL6 2015-12-02 41768337 IMPROVEMENT, RENOVATION, AND EQUIPPING HOSPITAL & REFUND PRIOR ISSUE 0 1 0 A 41768337 537891 768337 11902374 28559735 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 1 Schedule K, Part I, Column (f): The bond listed on Schedule K, Part I, Line A was partially used to refund bonds issued September 30, 2015. Form 990, Part VI, Section B, line 11b A PUBLIC ACCOUNTING FIRM PREPARED THE FORM 990. IT IS REVIEWED BY THE CFO AND CEO. THE COMPLETED FORM 990 IS REVIEWED IN ITS ENTIRETY BY ALL MEMBERS OF THE GOVERNING BOARD BEFORE IT IS FILED with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES COMPLETE A QUESTIONNAIRE ANNUALLY. QUESTIONNAIRES SUBMITTED BY OFFICERS (OTHER THAN THE PRESIDENT/CEO) AND KEY EMPLOYEES ARE REVIEWED BY THE PRESIDENT/CEO. QUESTIONNAIRES SUBMITTED BY THE PRESIDENT/CEO AND DIRECTORS ARE REVIEWED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS. ALL DISCLOSED CONFLICTS ARE REPORTED TO THE BOARD OF DIRECTORS. IF A CONFLICT IS IDENTIFIED, THE CONFLICTED INDIVIDUAL WILL NOT PARTICIPATE IN DELIBERATIONS AND DECISIONS IMPACTING THE CONFLICTED MATTER. Form 990, Part VI, Section B, line 15 CURRENT COMPARATIVE COMPENSATION INFORMATION IS OBTAINED FROM AN INDEPENDENT FIRM, MOST RECENTLY IN 2016. THE PRESIDENT & CEO EVALUATION COMMITTEE OF THE BOARD OF DIRECTORS USE THIS INFORMATION AND ITS EVALUATION OF PERFORMANCE TO SET THE ANNUAL COMPENSATION OF THE PRESIDENT/CEO. DOCUMENTATION OF THIS PROCESS IS RETAINED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS. THE PRESIDENT AND CEO EVALUATION COMMITTEE SETS THE TARGET LEVEL OF ANNUAL COMPENSATION FOR OFFICERS AND KEY EMPLOYEES NOT TO EXCEED THE 50TH PERCENTILE OF THE MARKET ANALYSIS PERFORMED BY THE INDEPENDENT COMPENSATION CONSULTANTS. THE PRESIDENT/CEO USES THE SAME PROCESS TO DETERMINE THE ANNUAL COMPENSATION ADJUSTMENTS OF OTHER OFFICERS AS WELL AS KEY EMPLOYEES. THE PRESIDENT/CEO DISCUSS THESE PROPOSED ANNUAL COMPENSATION ADJUSTMENTS WITH THE PRESIDENT AND CEO EVALUATION COMMITTEE OF THE BOARD OF DIRECTORS. DOCUMENTATION OF THIS PROCESS IS RETAINED BY THE PRESIDENT/CEO. Form 990, Part VI, Section C, line 19 REQUESTS TO VIEW THE CONFLICT OF INTEREST POLICY ARE MADE TO ADMINISTRATION. THE HOSPITAL DOES NOT MAKE EITHER THE GOVERNING/ORGANIZING DOCUMENTS OR AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, section A, column B K. LAWRENCE COHEN, MD AND KRISHNA NARAYANAN, MD ARE MEMBERS OF THE BOARD. THEY DEVOTE AN AVERAGE OF TWO HOURS PER WEEK RELATING TO THEIR ACTIVITIES ASSOCIATED WITH SERVING ON THE BOARD OF DIRECTORS. THE REPORTABLE COMPENSATION IS RELATED TO PROFESSIONAL MEDICAL SERVICES PROVIDED TO THE HOSPITAL AND ARE UNRELATED TO THE AVERAGE NUMBER OF HOURS PER WEEK. Montebello Community Health Services Inc 309 West Beverly Blvd Montebello CA 90640 953823550 SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION CA 501(c)(3) Line 12b, II BEVERLY COMMUNITY HOSPITAL ASSOCIATION 1 Beverly Hospital Foundation 309 West Beverly Blvd Montebello CA 90640 953823550 SUPPORT BEVERLY COMMUNITY HOSPITAL ASSOCIATION CA 501(c)(3) Line 7 BEVERLY COMMUNITY HOSPITAL ASSOCIATION 1 0 1 1 1 1 0 0 0 0 1 1 0 1 1 1 0 1 0 0 Beverly Hospital Foundation C 562238 Book Value montebello Community Health Services Inc D 3639470 Book Value Beverly Hospital Foundation D 206339 BOok Value montebello Community Health Services Inc E 3326565 Book Value montebello Community Health Services Inc J 111448 Book Value Montebello Community Health Services Inc K 266472 BOok Value